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Angiotensin-converting enzyme inhibitors and risk of age-related macular degeneration in individuals with hypertension

Subramanian, Anuradhaa; Han, Diana; Braithwaite, Tasanee; Thayakaran, Rasiah; Zemedikun, Dawit T; Gokhale, Krishna M; Lee, Wen Hwa; ... Adderley, Nicola J; + view all (2022) Angiotensin-converting enzyme inhibitors and risk of age-related macular degeneration in individuals with hypertension. British Journal of Clinical Pharmacology 10.1111/bcp.15366. (In press). Green open access

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Abstract

AIM: Several observational studies have examined the potential protective effect of angiotensin-converting enzyme inhibitor (ACE-I) use on the risk of age-related macular degeneration (AMD) and have reported contradictory results owing to confounding and time-related biases. We aimed to assess the risk of AMD in a base cohort of patients aged 40 and above with hypertension among new users of ACE-I compared to an active comparator cohort of new users of calcium channel blockers (CCB) using data obtained from IQVIA Medical Research database, a primary care database in the UK. METHODS: In this study, 53,832 and 43,106 new users of ACE-I and CCB were included between 1995 and 2019, respectively. In an on-treatment analysis, patients were followed up from the time of index drug initiation to the date of AMD diagnosis, loss to follow-up, discontinuation or switch to the comparator drug. A comprehensive range of covariates were used to estimate propensity scores to weight and match new users of ACE-I and CCB. Standardized mortality ratio (SMR) weighted Cox proportional hazards model was used to estimate hazard ratios (HRs) of developing AMD. RESULTS: During a median follow-up of 2 years (interquartile range 1-5 years), the incidence rate of AMD was 2.4 (95% CI 2.2-2.6) and 2.2 (2.0-2.4) per 1,000 person-years among the weighted new users of ACE-I and CCB, respectively. There was no association of ACE-I use on the risk of AMD compared to CCB use in either the propensity score weighted or matched, on-treatment analysis (aHR: 1.07 (95% CI 0.90-1.27) and 0.87 (0.71-1.07) respectively). CONCLUSION: We found no evidence that the use of ACE-I is associated with risk of AMD in patients with hypertension.

Type: Article
Title: Angiotensin-converting enzyme inhibitors and risk of age-related macular degeneration in individuals with hypertension
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/bcp.15366
Publisher version: https://doi.org/10.1111/bcp.15366
Language: English
Additional information: Copyright © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Keywords: Angiotensin-converting enzyme inhibitors, age-related macular degeneration, hypertension
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10147952
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